Bloom HoldCo Form 3 Bloom HoldCo / John Carlton Backus III ownership change

SEC Form 3

FORM 3

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940

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1. Name and Address of Reporting Person^*

Backus John Carlton III

(Last) (First) (Middle)

C/O BLOOM HOLDCO LLC,

1000 BRICKELL AVENUE, SUITE 715

(Street)

MIAMI FL 33131

(City) (State) (Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
08/04/2023

3. Issuer Name and Ticker or Trading Symbol
Bloom HoldCo LLC [ N/A ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

Director	X	10% Owner
Officer (give title below)		Other (specify below)

5. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4)	2. Amount of Securities Beneficially Owned (Instr. 4)	3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	4. Nature of Indirect Beneficial Ownership (Instr. 5)
Bloom HoldCo LLC Units(2)	1,800(1)	D

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4)	2. Date Exercisable and Expiration Date (Month/Day/Year)		3. Title and Amount of Securities Underlying Derivative Security (Instr. 4)		4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
	Date Exercisable	Expiration Date	Title	Amount or Number of Shares

Explanation of Responses:

1. In connection with the Issuer's organization as a limited liability company on December 27, 2017 under the laws of the State of Delaware, the Issuer issued 1,800 limited liability company units to Mr. Backus in exchange for his contribution of all of his limited liability company membership interest in Bloom Ltd.

2. The Bloom HoldCo LLC Units beneficially owned by Mr. Backus are "voting" limited liability company units in accordance with the Bloom HoldCo LLC Second Amended and Restated Limited Liability Company Operating Agreement.

Remarks:

Exhibit List: Exhibit 24 - Power of Attorney

	/s/ John Backus by Diana Bushard, Attorney in Fact	08/04/2023
	** Signature of Reporting Person	Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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